Talk:Diluting and combining insulin
Kathy, the Levemir literature I've seen gives very specific information about combining Levemir http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=14584#INTERACTIONS It doesn't say "Cannot be combined", it just warns against a certain combination. The article you quoted earlier that said not to combine Levemir didn't give any reason for it, was not direct from the manufacturer, and I'd tend to put that down more to CYA than to any actual reason or research. Likewise on dilution, Levemir might well be dilutable -- I spoke to the customer service department for Novo Nordisk and they thought it might be and sent me diluent. I then spoke to the customer department at Novo in a different country and they said not to dilute it, but gave no reason why. I suspect they just haven't tried. So I really would appreciate if you'd let the possibility stand, along with a warning that dilution/combining is untried and may be dangerous, rather than a blanket prohibition without much justification. I'm mentioning this in the talk page because I've tried to say this a few times on this page and the Levemir page, and you've kept changing it, based (as far as I know) on just one external source. Do you have any other sources? My reasoning is this: Levemir is based in ordinary isophane, and doesn't require any particular pH or suspension to function. Its time-delay is based on its molecular properties alone. So mixing and diluting, unless someone shows otherwise, are likely to work to some extent. Contrast this with Lantus which depends on EVERYTHING and you can see why I don't lump them together. --Steve and Jock 00:33, 22 Dec 2005 (UTC) Diluting Levemir We hope 16:10, 22 Dec 2005 (UTC) Steve, I also personally believe that it CAN be diluted and/or combined. Diluent would be that for NPH because of the protamine suspension. Believe it or not, it took them ages to experiment with the NPH diluent and say that Humalog & Novolog could be used with NPH diluent and combined with other insulins. Can see how Lantus may not fly diluted because of the sub-Q crystal mechanism; Levemir doesn't have this. It possibly may become proven once it gets to the US and is used more in pediatric cases. For Lantus, if dilution can be accomplished, it will need to be with R diluent. Example is how long (and still not official) it took to get studies re: combining Lantus. The drive to get data on combining comes from Aventis--trying to sell more product (especially to kids) by making its use simpler. We can point to these studies, but it's still not official. I think I'm guilty of CYA in the case of wiki and this was why I was changing this. Having been at CDMB for a while, one gets into the habit of needing to do this to make sure someone understood what you were trying to say; newbies often confuse easily and my habit was to "cover" everything. The unproven dilution of Levemir is fine--will not be changing it--we are both comfortable with the unknown status. SORRY!! Kathy